Periodic Health Examinations in Primary Care DR. KHALED ALDOSSARI SBFM,ABFM,MBBS.
Periodic Health Examinations: A Rapid Review...Periodic Health Examinations: A Rapid Review....
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Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26.
Periodic Health Examinations: A Rapid
Review
K Kaulback
November 2012
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 2
Suggested Citation
This report should be cited as follows:
Kaulback K. Periodic health examinations: a rapid review. Toronto, ON: Health Quality Ontario; 2012 Nov. 26 p.
Available from: http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/rapid-reviews.
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Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 3
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Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 4
Table of Contents
Table of Contents ........................................................................................................................................ 4
List of Abbreviations .................................................................................................................................. 5
Background ................................................................................................................................................. 6
Objective of Analysis .................................................................................................................................................... 6
Clinical Need and Target Population ............................................................................................................................. 6
Rapid Review ............................................................................................................................................... 7
Research Questions........................................................................................................................................................ 7
Research Methods.......................................................................................................................................................... 7
Literature Search .................................................................................................................................................. 7
Inclusion Criteria .................................................................................................................................................. 7
Exclusion Criteria ................................................................................................................................................. 7
Outcomes of Interest ............................................................................................................................................. 7
Quality of Evidence ....................................................................................................................................................... 7
Results of Literature Search........................................................................................................................................... 8
Cochrane Systematic Review ................................................................................................................................ 8
Agency for Health Quality and Research Systematic Review ............................................................................... 8
United States Veterans Affairs/Department of Defence Evidence Brief ............................................................... 9
Evidence Development and Standards Review ................................................................................................... 10
Conclusions ................................................................................................................................................ 11
Acknowledgements ................................................................................................................................... 12
Appendices ................................................................................................................................................. 13
Appendix 1: Literature Search Strategies .................................................................................................................... 13
Appendix 2: Recommended Screening Intervals From Major Governmental Preventive Health Organizationsa ....... 16
References .................................................................................................................................................. 23
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 5
List of Abbreviations
AACE American Association of Clinical Endocrinologists
AAFP American Association of Family Physicians
ACOG American College of Obstetricians and Gynecologists
ACP American College of Physicians
ADA American Diabetes Association
AMSTAR Assessment of Multiple Systematic Reviews
ATA American Thyroid Association
BMD Bone mineral density
BMI Body mass index
CAS Coronary artery stenosis
CDA Canadian Diabetes Association
CHD Coronary heart disease
CTFPHC Canadian Task Force on Preventive Health Care
CV Cardiovascular
EBCT Electron-beam computerized tomography
ECG Electrocardiography
ETT Exercise treadmill test
FOBT Fecal occult blood test
FPG Fasting plasma glucose
GP General practitioner
HbA1c Hemoglobin A1c
HPV Human papillomavirus
JNC7 Joint National Committee on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure
NHS National Health Service
NSC National Screening Committee
OGTT Oral glucose tolerance test
PHE Periodic health examination
RCT Randomized controlled trial
TSH Thyroid-stimulating hormone
USPSTF United States Preventive Services Task Force
VA/DoD Veterans Affairs/Department of Defence
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 6
Background
Objective of Analysis
The objective of this analysis was to determine whether periodic health examinations (PHEs) improve
health outcomes in asymptomatic adults, and the optimal frequency at which PHEs should be offered.
Clinical Need and Target Population
Periodic health examinations are conducted in asymptomatic adults, and are defined as 1 or more visits
with a heath care provider for the primary purpose of assessing overall health and risk factors for disease.
(1) There is no consensus about the components that should be included in a routine PHE, the frequency
with which a PHE should occur, or the necessity of a routine PHE.
Overuse, underuse, and misuse of interventions are important concerns in health care and lead to
individuals receiving unnecessary or inappropriate care. In April 2012, under the guidance of the
Ontario Health Technology Advisory Committee’s Appropriateness Working Group, Health Quality
Ontario (HQO) launched its Appropriateness Initiative. The objective of this initiative is to develop a
systematic framework for the ongoing identification, prioritization, and assessment of health
interventions in Ontario for which there is possible misuse, overuse, or underuse.
For more information on HQO’s Appropriateness Initiative, visit our website at www.hqontario.ca.
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 7
Rapid Review
Research Questions
1. What is the evidence to support periodic health examinations in asymptomatic adults?
2. What are the recommended screening intervals for the usual components of periodic health
examinations?
Research Methods
Literature Search
A literature search was performed on September 28, 2012, using OVID MEDLINE, MEDLINE In-
Process and Other Non-Indexed Citations, OVID EMBASE, the Wiley Cochrane Library, and the Centre
for Reviews and Dissemination database, for studies published from January 1, 2006, until September 28,
2012. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria,
full-text articles were obtained. Reference lists were also examined for any additional relevant studies not
identified through the search, and a general search of the Internet was conducted.
Inclusion Criteria
English language
published between January 1, 2006, and September 28, 2012
health technology assessments, systematic reviews, or meta-analyses
adults
Exclusion Criteria
randomized controlled trials, observational studies, case reports, editorials, letters
abstracts, conference proceedings
Outcomes of Interest
improved patient outcomes, optimal screening intervals
Quality of Evidence
The Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool was used to assess the
methodological quality of the systematic reviews selected for inclusion. (2)
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Results of Literature Search
The database search yielded 428 citations published between January 1, 2006, and September 28, 2012
(with duplicates removed). Articles were excluded based on information in the title and abstract. The full
texts of potentially relevant articles were obtained for further assessment. The reference lists of the
included reviews were hand searched to identify any additional potentially relevant studies.
Three articles (3 systematic reviews) met the inclusion criteria, and are summarized below. (1;3;4)
Cochrane Systematic Review
Krogsbøll et al (4) evaluated the benefits and harms of general health checks with an emphasis on patient-
relevant outcomes such as morbidity and mortality rather than on surrogate outcomes such as blood
pressure and serum cholesterol levels. They describe general health checks as a synonym of PHEs, and
defined these exams as screening for more than 1 disease or risk factor and in more than 1 organ system,
whether performed only once or repeatedly. They included 16 RCTs and rated the quality of evidence
using the system developed by the GRADE Working Group (6) with results as shown in Table 1. The
risk ratios for total mortality, cardiovascular mortality, and cancer mortality were all insignificant,
indicating that the general health check did not have an impact. In terms of other outcomes, the authors
did not find an effect on hospitalizations, disability, worry, additional visits to the physician, absence
from work, number of referrals to specialists, the number of follow-up tests after positive screening
results, or the amount of surgery. The authors concluded general health checks were unlikely to be
beneficial given that they did not lead to reductions in morbidity and mortality, even though the number
of new diagnoses increased.
The AMSTAR measurement tool was used to assess the methodological quality of this systematic review;
the overall score was 10 out of 11.
Table 1: Summary of Outcomes
Outcomea Risk Ratio (CI) Quality of Evidence
(GRADE) Total Studies/ Participants
Total mortality 0.99 (0.95–1.03) High 9/155,899
Cardiovascular mortality 1.03 (0.91–1.17) Moderate 8/152,435
Cancer mortality 1.01 (0.92–1.12) High 8/139,290
Abbreviation: CI, confidence interval. aFollow-up: 4–22 years.
Agency for Health Quality and Research Systematic Review
Boulware et al (1;5) performed a systematic review on behalf of the Agency for Health Quality and
Research to determine the benefits and harms of the PHE and summarize the results of the best available
evidence. The included studies evaluated a total of 17 outcomes relevant for PHEs spread across 3 general
categories: delivery of clinical preventive services, proximal clinical outcomes, and distal
clinical/economic outcomes. Of the 17 outcomes, beneficial effects (in terms of range of magnitude of the
PHE) were reported for 4 (Table 2).
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Table 2: Summary of Best Available Evidence for Outcomes with Beneficial Effects
Outcomes With Beneficial Effects Studies Quality of Evidencea
Delivery of Clinical Preventive Services
Gynecologic exam/Pap smear RCTs (2) High
Cholesterol screening RCTs (1), observational studies (4) Medium
Colon cancer screening RCTs (2) High
Proximal Clinical Outcomes
Patient attitudes RCTs (1) Medium
Abbreviation: RCT, randomized controlled trial. aQuality of evidence was assessed using the GRADE classification system. (6)
Source: Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D et al. Systematic review: the value of the periodic health evaluation. Ann Intern Med.2007;146(4):289-300. (1)
Mixed effects were reported for delivery of other clinical preventive services (counselling,
immunizations, mammography) proximal clinical outcomes (disease detection, health habits, health
status, blood pressure, serum cholesterol, body mass index) and distal economic and clinical outcomes
(costs, disability, hospitalization, mortality).
The authors did not report on the frequency and intensity of any specific components of the PHE, but they
did highlight a need for more research in this area.
The AMSTAR measurement tool was used to assess the methodological quality of this systematic review;
the overall score was 10 out of 11.
United States Veterans Affairs/Department of Defence Evidence Brief
An October 2011 Evidence Brief from Bloomfield and Wilt (3) for the United States Veterans
Affairs/Department of Defence (VA/DoD) evaluated the components of the PHE that were currently
recommended by evidence-based guidelines or reports. The authors used the United States Preventive
Services Task Force (USPSTF) recommendations to identify common components of the PHE, and for
components not included by the USPSTF, they performed a systematic literature search.
Based on their analysis, the authors concluded that PHEs in asymptomatic results could not be
recommended due to a lack of evidence. However, they did cite USPSTF recommendations to provide
the following:
blood pressure screening every 1 to 2 years (no evidence for optimal interval, but the VA/DoD
recommended annually; a 1 year recommendation was also provided for persons with an initial
blood pressure reading of 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic by the Joint
Committee on Prevention Diagnosis and Treatment of High Blood Pressure)
periodic (unspecified frequency) body mass index screening
Pap smears beginning at age 21 for sexually active women with a cervix every 3 years until 65
years of age
The AMSTAR measurement tool was used to assess the methodological quality of this evidence brief; the
overall score was 3 out of 11.
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 10
Evidence Development and Standards Review
The Evidence Development and Standards branch at Health Quality Ontario expanded on the work of the
VA/DoD evidence brief to determine optimal screening intervals for the various components of the
typical PHE. Recommendations from the following government preventive services recommendation
bodies/websites were reviewed, and the findings are summarized in Appendix 1.
Canada
– Canadian Task Force on Preventive Health Care (7)
United States
– United States Preventive Services Task Force (8)
– American Academy of Family Physicians (9)
– Veterans Affairs/Department of Defence (10)
United Kingdom
– UK National Screening Committee (11)
– National Health Service Health Check (12)
– National Health Service Cancer Screening Programs (12;13)
No annual or more frequent screening intervals were recommended for healthy, average-risk,
asymptomatic adults for any of the health conditions reviewed, with the exception of VA/DoD
recommendations (10) for annual screening of body mass index (2006) and blood pressure (2005), both of
which are based on expert opinion and are not supported by the other organizations included in the
review.
An annual or biennial fecal occult blood test (FOBT) is recommended in adults over 50 years (Canadian
Task Force on Preventive Health Care/USPSTF), (7;8) although colonoscopy/sigmoidoscopy every 5 to
10 years is recommended as an alternative.
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 11
Conclusions
While the PHE may have a beneficial effect on the delivery of some clinical preventive services and may
alleviate patient worry, there is no evidence that it has an impact on other outcomes, including morbidity,
mortality, hospitalization, visits to physicians, referrals, or absence from work. Based on a review of the
recommendations from large government preventive services organizations in Canada, the United States,
and the United Kingdom, there is no consensus on the optimal frequency of screening for the various
components of a typical PHE, and there are no recommendations based on evidence to support annual or
more frequent screening.
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Acknowledgements
Editorial Staff Jeanne McKane, CPE, ELS(D)
Medical Information Services Kaitryn Campbell, BA(H), BEd, MLIS
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 13
Appendices
Appendix 1: Literature Search Strategies
Search date: September 28, 2012 Databases searched: OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE; Cochrane Library; CRD Q: Periodic health exams Limits: 2006-current; English Filters: health technology assessments, systematic reviews, and meta-analyses Database: Ovid MEDLINE(R) <1946 to September Week 3 2012>, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations <September 27, 2012>, Embase <1980 to 2012 Week 38> Search Strategy:
# Searches Results
1 *Physical Examination/ 15504
2 *Mass Screening/ 59656
3 or/1-2 74720
4 *Primary Health Care/ use mesz 30897
5 *Primary Prevention/ 10655
6 *Preventive Health Services/ use mesz 6311
7 exp *General Practice/ 73952
8 *Preventive Medicine/ use emez 8600
9 *Preventive Health Service/ use emez 9863
10 exp *Primary Health Care/ use emez 36674
11 or/4-10 171254
12 *Multiphasic Screening/ use mesz 662
13 *Periodic Medical Examination/ use emez 528
14 (periodic adj (physical examination? or health exam? or health examination? or health evaluation? or screening? or check up or checkup or health check up or health checkup)).ti,ab.
2213
15 ((annual or yearly) adj (physical examination? or health exam? or health examination? or health evaluation? or screen or screening? or check up or checkup or health check up or health checkup)).ti,ab.
3042
16 ((multiphasic or multi-phasic) adj (health exam? or health examination? or health evaluation? or screening? or check up or checkup or health check up or health checkup or health testing)).ti,ab.
716
17 (preventive adj (physical examination? or health exam? or health examination? or health evaluation? or screening? or check up or checkup or health check up or health checkup or service? delivery or service?)).ti,ab.
7296
18 (medical surveillance or primary care screening).ti. 588
19 or/12-18 14433
20 (3 and 11) or 19 16909
21 (2006* or 2007* or 2008* or 2009* or 201*).ed. 5816149
22 (2006* or 2007* or 2008* or 2009* or 201*).em. 12810155
23 or/21-22 12810155
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 14
24 Meta Analysis.pt. 36479
25 Meta Analysis/ use emez 65909
26 Systematic Review/ use emez 53173
27 exp Technology Assessment, Biomedical/ use mesz 8853
28 Biomedical Technology Assessment/ use emez 11380
29 (meta analy* or metaanaly* or pooled analysis or (systematic* adj2 review*) or published studies or published literature or medline or embase or data synthesis or data extraction or cochrane).ti,ab.
289908
30 ((health technolog* or biomedical technolog*) adj2 assess*).ti,ab. 3641
31 or/24-30 349592
32 20 and 23 and 31 700
33 limit 32 to english language 694
34 remove duplicates from 33 398
Cochrane Library
Line # Terms Results #1 MeSH descriptor: [Physical Examination] this term only 700
#2 MeSH descriptor: [Mass Screening] this term only 3614
#3 #1 or #2 4247
#4 MeSH descriptor: [Primary Health Care] this term only 2412
#5 MeSH descriptor: [Primary Prevention] this term only 593
#6 MeSH descriptor: [Preventive Health Services] this term only 413
#7 MeSH descriptor: [General Practice] explode all trees 2122
#8 #4 or #5 or #6 or #7 5170
#9 #3 and #8 384
#10 MeSH descriptor: [Multiphasic Screening] this term only 16
#11 periodic next (physical examination? or health exam? or health examination? or health evaluation? or screening? or check up or checkup or health check up or health checkup):ti,ab,kw or (annual or yearly) next (physical examination? or health exam? or health examination? or health evaluation? or screen or screening? or check up or checkup or health check up or health checkup):ti,ab,kw or (multiphasic or multi-phasic) next (health exam? or health examination? or health evaluation? or screening? or check up or checkup or health check up or health checkup or health testing):ti,ab,kw or preventive next (physical examination? or health exam? or health examination? or health evaluation? or screening? or check up or checkup or health check up or health checkup or service? delivery or service?):ti,ab,kw or medical surveillance or primary care screening:ti (Word variations have been searched)
447
#12 #9 or #10 or #11 315 from 2006 to present
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 15
CRD
Line Search Hits
1 MeSH DESCRIPTOR Physical Examination IN DARE,HTA 88
2 MeSH DESCRIPTOR Mass Screening IN DARE,HTA 738
3 #1 OR #2 820
4 MeSH DESCRIPTOR Primary Health Care IN DARE,HTA 326
5 MeSH DESCRIPTOR Primary Prevention IN DARE,HTA 123
6 MeSH DESCRIPTOR Preventive Health Services IN DARE,HTA 55
7 MeSH DESCRIPTOR General Practice EXPLODE ALL TREES 255
8 #4 OR #5 OR #6 OR #7 712
9 #3 AND #8 58
10 MeSH DESCRIPTOR Multiphasic Screening IN DARE,HTA 0
11
(periodic ADJ (physical examination? OR health exam? OR health examination? OR health evaluation? OR screening? OR check up OR checkup OR health check up OR health checkup)):TI OR ((annual OR yearly) ADJ (physical examination? OR health exam? OR health examination? OR health evaluation? OR screen OR screening? OR check up OR checkup OR health check up OR health checkup)):TI OR ((multiphasic OR multi-phasic) ADJ (health exam? OR health examination? OR health evaluation? OR screening? OR check up OR checkup OR health check up OR health checkup OR health testing)):TI OR (preventive ADJ (physical examination? OR health exam? OR health examination? OR health evaluation? OR screening? OR check up OR checkup OR health check up OR health checkup OR service? delivery OR service?)):TI OR (medical surveillance OR primary care screening):TI IN DARE, HTA WHERE PD FROM 01/01/2006 TO 28/09/2012
64
12 #9 OR #10 OR #11 112
DARE & HTA (2006-current)=78
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 16
Appendix 2: Recommended Screening Intervals From Major
Governmental Preventive Health Organizationsa
Indication Screening Interval Reference (last visited October 10, 2012)
Breast cancer
CTFPHC
The CTFPHC (2011) recommends not routinely performing a clinical breast exam alone or in conjunction with mammography to screen for breast cancer, or routinely screening with magnetic resonance imaging
For women aged 40–49, we recommend not routinely screening with mammography
For women aged 50–69, we recommend routinely screening with mammography every 2 to 3 years
For women aged 70–74, we recommend routinely screening with mammography every 2 to 3 years
http://www.canadiantaskforce.ca/docs/CBE_BSE_recommendation_ENG.pdf
AAFP
The AAFP recommends that the decision to conduct screening mammography before age 50 should be individualized and take into account patient context, including her risks as well as her values regarding specific benefits and harms
The AAFP (2012) recommends biennial (every 2 years) screening mammography for women 50–74
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
UK NSC
Women aged 50–70 should be screened every 3 years
http://www.screening.nhs.uk/cms.php?folder=2487
NHS Breast Cancer Screening Program
Women under 50 are not currently offered routine screening. Research has shown that routine screening in the 40–50 age group is less effective
Digital mammography is better for screening younger women and women with denser breasts, and is as effective as film mammography in older women
The program is being gradually extended to women aged 47–49, as well as to those aged 71–73. The age extension of the program is expected to be complete by 2016. It is important to note that women of any age can ask their GP to refer them to a hospital breast clinic if they are concerned about a specific breast problem or otherwise worried about the risk of breast cancer
http://www.cancerscreening.nhs.uk/breastscreen/under-50.html
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 17
Cervical cancer
CTFPHC
The CTFPHC recommendation is currently in progress
—
AAFP
The AAFP recommends screening for cervical cancer in women age 21–65 years with cytology (Pap smear) every 3 years or, for women age 30–65 years who want to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
CancerHelp/UK NSC
Every 3–5 years for women aged approximately 20–64 (varies by country)
http://cancerhelp.cancerresearchuk.org/type/cervical-cancer/about/cervical-cancer-screening
http://www.screening.nhs.uk/policydb_download.php?doc=219
NHS Cervical Screening Program
All women between the ages of 25–64 are eligible for a free cervical screening test every 3–5 years
http://www.cancerscreening.nhs.uk/cervical/about-cervical-screening.html#eligible
Colorectal cancer
CTFPHC
The CTFPHC (2001) found that there is good evidence to support the inclusion of annual or biennial FOBT and fair evidence to include flexible sigmoidoscopy in the periodic health examinations of asymptomatic individuals over age 50 years
http://www.canadiantaskforce.ca/recommendations/2001_03_eng.html
USPSTF
The USPSTF (2008) reports that modelling evidence suggests that population screening programs between the ages of 50 and 75 years using any of the following 3 regimens will be approximately equally effective in life-years gained, assuming 100% adherence to the same regimen for that period: 1) annual high-sensitivity FOBT, 2) sigmoidoscopy every 5 years combined with high-sensitivity FOBT every 3 years, and 3) screening colonoscopy at intervals of 10 years; although use of an annual FOBT with a lower sensitivity has been demonstrated to reduce colorectal cancer mortality in randomized, controlled trials, modelling suggests that the number of life-years gained will be greater with the strategies using higher-sensitivity tests
http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm#clinical
CancerHelp/UK NSC
FOBT every 2 years in people aged approximately 50–74 (by 2015)
http://cancerhelp.cancerresearchuk.org/type/bowel-cancer/about/screening/who-is-screened-for-bowel-cancer
http://www.screening.nhs.uk/cms.php?folder=2489
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 18
Colorectal cancer (cont’d)
NHS Bowel Cancer Screening Program
The NHS Bowel Cancer Screening Programme offers FOBT screening every 2 years to all men and women aged 60–69. The NHS is introducing flexible sigmoidoscopy (flexi-sig) screening for all men and women when they reach the age of 55. This screening test is an addition to the existing NHS Bowel Cancer Screening Programme (FOBT), and will be offered to people aged 55. People aged over 55 will be able to request flexi-sig screening up to their 60th birthday. At 60, people will be offered the FOBT as now, whether or not they have had flexi-sig screening. Screening interval with flexi-sig not yet available
http://www.cancerscreening.nhs.uk/bowel/flexible-sigmoidoscopy-screening.html
Coronary heart disease, low-risk
AAFP
The AAFP recommends against routine screening with resting ECG, ETT, or EBCT scanning for coronary calcium for either the presence of severe CAS or the prediction of CHD events in adults at low risk for CHD events
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
Coronary heart disease, high-risk
AAFP
The AAFP found insufficient evidence to recommend for or against routine screening with ECG, ETT, or EBCT scanning for coronary calcium for either the presence of severe CAS or the prediction of CHD events in adults at increased risk for CHD events
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
UK NSC
Recommends screening every 5 years in adults aged 40–74. Screening consists of blood pressure, cholesterol, and BMI tests
http://www.screening.nhs.uk/policydb.php
Depression CTFPHC
The CTFPHC (2005, update currently in progress) concludes that there is fair evidence to recommend screening adults for depression in primary care settings, since screening improves health outcomes when linked to effective follow-up and treatment, but insufficient evidence to recommend for or against screening adults for depression in primary care settings where effective follow-up and treatment are not available
http://www.canadiantaskforce.ca/recommendations/2005_02_eng.html
USPSTF
Although the optimal interval for screening is unknown, the USPSTF (2009) stated that “recurrent screening may be most productive in patients with past history of depression, unexplained somatic symptoms, comorbid psychological conditions (such as panic disorder or generalized anxiety), substance abuse, or chronic pain”
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
UK NSC
Population screening not recommended
http://www.uspreventiveservicestaskforce.org/uspstf09/adultdepression/addeprrs.htm#clinical
http://www.screening.nhs.uk/depression
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 19
Diabetes, type 2
CTFPHC
The CTFPHC (2005, update currently in progress) states that there is fair evidence to recommend screening adults with hypertension for type 2 diabetes to reduce the incidence of CV events and mortality. There is fair evidence to recommend screening adults with hyperlipidemia for type 2 diabetes to reduce the incidence of CV events and mortality. CTFPHC states that there is no information regarding optimal screening frequency
CDA
The CDA recommends screening for diabetes with a fasting plasma glucose test every 3 years in people 40 years of age and older (grade: consensus). Screening should be considered at an earlier age or be performed more frequently, or both, using a fasting glucose or 2-hour OGTT in people with additional risk factors for diabetes (grade: consensus)
http://www.canadiantaskforce.ca/recommendations/2005_03_eng.html
AAFP
The AAFP indicates that the optimal screening interval is not known and recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg
ADA
The ADA, on the basis of expert opinion, recommends that patients, particularly those with a BMI of 25 kg/m
2 or greater,
be screened with a fasting glucose test every 3 years beginning at the age of 45 years
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
VA/DoD
Screening for prediabetes or diabetes should be considered for all adults age ≥ 45 years
Screening for prediabetes or diabetes should be considered in younger adults who are overweight or obese (BMI > 25 kg/m
2) or are at high risk for diabetes
mellitus based upon established risk factors at 1–3 year intervals
Screening for prediabetes or diabetes should occur at a frequency of 1–3 years. More frequent screening can be performed depending upon prior HbA1c or FPG results, and patient or clinician preferences
http://www.uspreventiveservicestaskforce.org/uspstf08/type2/type2summ.htm
http://www.healthquality.va.gov/diabetes/DM2010_SUM-v4.pdf
UK NSC
General population screening should not be offered
http://www.screening.nhs.uk/policydb.php
NHS Health Check (UK)
Recommends screening every 5 years in adults aged 40–74. Screening consists of blood pressure, cholesterol, and BMI tests. OGTT offered if high risk for developing diabetes is perceived
http://www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthCheckwhat.aspx
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 20
Dyslipidemias AAFP
While the AAFP recommends screening for lipid disorders in specified population groups, the optimal interval for screening is uncertain. On the basis of other guidelines and expert opinion, reasonable options include every 5 years, shorter intervals for people who have lipid levels close to those warranting therapy, and longer intervals for those not at increased risk who have had repeatedly normal lipid levels
http://www.uspreventiveservicestaskforce.org/uspstf08/lipid/lipidrs.htm
VA/DoD
All men age 35 years or older and women age 45 years or older, every 5 years
http://www.healthquality.va.gov/lipids/lipid_sum.pdf
NHS Health Check (UK)
Recommended for adults aged 40–74 every 5 years
http://www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthCheckwhat.aspx
Hypertension/blood pressure
CTFPHC
Recommendation currently in progress
—
AAFP
The AAFP recommends screening for high blood pressure in adults aged 18 and older, but the optimal interval for screening adults for hypertension is not known
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
JNC7
The JNC7 recommends the following:
Screening every 2 years in patients with blood pressure < 120/80 mm Hg
Screening every year in patients with systolic blood pressure of 120–139 mmHg or diastolic blood pressure of 80–90 mm Hg
http://www.uspreventiveservicestaskforce.org/uspstf07/hbp/hbpsum.htm
VA/DoD (2005)
Blood pressure screening should occur periodically
Blood pressure screening is recommended annually for adults 50 years of age and older and/or for those who have prehypertension and/or other cardiovascular risk factors
Blood pressure screening is recommended at indeterminate intervals, preferably annually. This may occur at the time of routine preventive care or routine health assessments
“Evidence is lacking to recommend an optimal interval for screening adults for high blood pressure. A reasonable timeframe can be inferred based on age, baseline blood pressure, and cardiovascular risks but as a general recommendation, it seems prudent and most straightforward to assess at yearly intervals since most people, especially those over the age of fifty, require an annual assessment or follow-up for other medical issues”
http://www.ncbi.nlm.nih.gov/books/NBK82767/table/vaphysical.t1/?report=objectonly
http://www.healthquality.va.gov/hypertension/htn04_pdf1.pdf
UK NSC
Population screening not recommended
http://www.screening.nhs.uk/policydb.php
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 21
NHS Health Check (UK)
Recommended for adults aged 40–74 every 5 years
http://www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthCheckwhat.aspx
Kidney disease
NHS Health Check (UK)
Recommended for adults aged 40–74 every 5 years
http://www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthCheckwhat.aspx
Obesity/BMI AAFP
While the AAFP recommends screening for obesity, no evidence was found regarding appropriate intervals for screening
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obesers.htm#clinical
VA/DoD (2006)
Screening for overweight and obesity should be performed at least annually (expert opinion)
http://www.ncbi.nlm.nih.gov/books/NBK82767/table/vaphysical.t1/?report=objectonly
http://www.healthquality.va.gov/obesity/ObesitySum508.pdf
NHS Health Check (UK)
Recommended for adults aged 40–74 every 5 years
http://www.nhs.uk/Planners/NHSHealthCheck/Pages/NHSHealthCheckwhat.aspx
Osteoporosis CTFPHC
The CTFPHC (2002) concluded that there is fair evidence to screen postmenopausal women to prevent fragility fractures, but the recommendation document does not identify recommended screening intervals
http://www.canadiantaskforce.ca/recommendations/2002_03_eng.html
AAFP
The AAFP (2011) recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. A lack of evidence exists about optimal intervals for repeated screening and whether repeated screening is necessary in a woman with normal BMD. Because of limitations in the precision of testing, a minimum of 2 years may be needed to reliably measure a change in BMD; however, longer intervals may be necessary to improve fracture risk prediction
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm#clinical
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 22
Thyroid disease
CTFPHC
The CTFPHC recommends maintaining a high index of clinical suspicion for nonspecific symptoms consistent with hypothyroidism when examining perimenopausal and postmenopausal women
—
AAFP
The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for thyroid disease in adults
ATA
The ATA recommends measuring thyroid function in all adults beginning at age 35 years and every 5 years thereafter, noting that more frequent screening may be appropriate in high-risk or symptomatic individuals
ACP
The ACP recommends screening women older than age 50 with 1 or more general symptoms that could be caused by thyroid disease
AACE
The AACE recommends TSH measurement in women of childbearing age before pregnancy or during the first trimester
ACOG
The ACOG recommends that physicians be aware of the symptoms and risk factors for postpartum thyroid dysfunction and evaluate patients when indicated
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/June2012CPS.pdf
http://www.uspreventiveservicestaskforce.org/3rduspstf/thyroid/thyrrs.htm
UK NSC
The UK NSC does not recommend thyroid screening
http://www.screening.nhs.uk/policydb.php
Abbreviations: AACE, American Association of Clinical Endocrinologists; AAFP, American Association of Family Physicians; ACOG, American College of Obstetricians and Gynecologists; ACP, American College of Physicians; ADA, American Diabetes Association; ATA, American Thyroid Association; BMD, bone mineral density; BMI, body mass index; CAS, coronary artery stenosis; CDA, Canadian Diabetes Association; CHD, coronary heart disease; CTFPHC, Canadian Task Force on Preventive Health Care; CV, cardiovascular; EBCT, electron-beam computerized tomography; ECG, electrocardiography; ETT, exercise treadmill test; FOBT, fecal occult blood test; FPG, fasting plasma glucose; GP, general practitioner; HbA1c, hemoglobin A1c; HPV, human papillomavirus; JNC7, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NHS, National Health Service; NSC, National Screening Committee; OGTT, oral glucose tolerance test; TSH, thyroid-stimulating hormone; USPSTF, United States Preventive Services Task Force; VA/DoD; Veterans Affairs/Department of Defence. aRecommendations from societies and associations were included where they were reported by the governmental organizations.
Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 23
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Periodic Health Examinations: A Rapid Review. November 2012; pp. 1–26. 26
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